Abstract
Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction and its management is usually conservative with nasojejunal feeding. The pathophysiology entails the loss of the fat pad between the superior mesenteric artery and the abdominal aorta. This reduces the angle between the two vessels to less than 20 degrees with the resultant compression of the third part of the duodenum. The surgical management is usually a laparoscopic duodenojejunostomy. The two cases in our series had two different surgical procedures with good outcomes in both patients. The surgical management of each patient should be determined on its own merits irrespective of the standard of care.
Highlights
The surgical management of superior mesenteric artery (SMA) syndrome in the modern era is reserved for medically refractive cases
Superior mesenteric artery (SMA) syndrome is a rare cause of small bowel obstruction [4]
The diagnosis is confirmed by the loss of an angle between the superior mesenteric artery and the abdominal aorta to less than 20 degrees [5]
Summary
The surgical management of superior mesenteric artery (SMA) syndrome in the modern era is reserved for medically refractive cases. Its success rate over a 5-year follow-up period is over 90 percent [2]. We present two cases of SMA syndrome with differing surgical approaches both of which have been successful. Strong’s procedure in the first case has been followed up for over four years with no attendant morbidity and a complete resolution of symp-toms. In the second case we were unable to perform Strong’s procedure due to a previous subtotal colectomy performed on the patient for colitis. Her follow-up over the past two years has been uneventful
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